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Heart Breaking

Hit in the chest by a baseball, a seven-year-old Georgia boy was tragically killed by a rare heart injury, says leading expert at Tufts. Marietta, Georgia.

Medford/Somerville, Mass. [05.22.02] The death of seven-year-old Nader Parman II was a complete shock. Playing a game of pick-up baseball in his front yard, the Georgia boy was hit in the chest by a ball, dying within minutes. What appeared to be a harmless accident -- which hardly left a bruise on the boy's chest -- was actually a rare, but often fatal injury, says a leading expert at Tufts.

In an interview with "Good Morning America," Tufts School of Medicine's Dr. Mark Link explained that a combination of timing, location and bad luck were responsible for Parman's death.

"The ball hit [him] in the area right above his heart, at exactly the right millisecond to cause a fatal abnormal heart rhythm and trigger cardiac arrest," reported the news program.

Called "commotio cordis," the irregular rhythm can be fatal, regardless of whether the victim had a healthy heart, said Link, who is a leading expert on sudden death and the director of the Center for the Evaluation of Athletes at the Tufts-New England Medical Center.

"[Link said] a normal heart beats more than 100,000 times a day," reported "Good Morning America.""But when a baseball or other hard object strikes the wrong spot during the 15 milliseconds between beats, the heart's electrical wiring is thrown off. The heart quits beating, and instead 'fibrillates,' or quivers inside the chest."

Normal life-saving techniques like CPR can do little to correct the rhythm.

According to the Atlanta Journal and Constitution, "[Link said] saving a victim of commotio cordis requires defibrillation -- shock treatments -- within three minutes. CPR can extend that window by just a few minutes."

If a heart defibrillator is not available immediately, there is little else that can be done.

"After three to five minutes, if you cannot get the individual back into their regular rhythm, it's unlikely that they'll survive," Link told "Good Morning America."

While very few of these cases are reported each year, experts like Link -- who wrote about the injury in the Journal of the American Medical Association -- do have some statistics about commotio cordis.

"The vast majority of the victims die," reported "Good Morning America.""Nearly all of them are male, under the age of 20, which is when the chest wall finishes developing. The most vulnerable are children under the age of 12 whose chest cages are narrow, and who have underdeveloped chest muscles."

Perhaps of most concern to parents, the fatal injury can be caused without a great deal of force. Anything from the impact of a baseball or football to bodily contact while playing with a pet, or even "attempts to remedy hiccups" could cause this type of injury.

But Link says parents should worry too much about preventing the highly unusual injury.

"The impact has to occur directly over the heart," the Tufts professor told "Good Morning America.""It has to occur during a very narrow time segment of the cardiac cycle, which is about one to two percent of the cardiac cycle. It's also important that the energy of impact is correct. It can't be too fast or two slow."

In some senses, it requires some very bad luck.

"So many variables have to fall in place for this fatal abnormal heart rhythm to occur," he told the Journal and Constitution.